Association Between Social Determinants of Health and Receiving Timely Dental Treatment With General Anesthesia.

Purpose: To describe social determinants of health (SDOH) in a group of children with special health care needs (CSHCN) planned for dental procedures with general anesthesia (GA) at a pediatric hospital and explore associations between SDOH and completing this treatment in the recommended timeframe. Methods: SDOH were recorded for all patients planned for dental treatment with GA in 2019. Outcomes were treatment completed in the recommended timeframe or treatment not completed within two years of planning. Results: Dental surgery plans were made for 390 CSHCN: 190 were completed in the recommended timeframe, and 119 were not completed within two years. The SDOH associated with completing/not completing surgery were parents (guardian/caregiver)/household, and documentation of social work involvement with the family. Patients receiving optimally timed surgery more frequently had two parents/one household and/or an active social work plan on the record. Those not receiving surgery frequently had two parents/two households, single parents, and/or had no social work plan. Ethnicity, payer, and the need for an interpreter were not associated with receiving timely surgery. Conclusions: Multiple studies have found that social determinants of health contribute to disparate health outcomes. In this study, children with two parents in one household appear to be advantaged in receiving care in the recommended timeframe. Families with SDOH challenges who had a social work plan were frequently able to overcome SDOH barriers and receive dental treatment with general anesthesia in the timeframe recommended.

Territorial Disparities in Dental Care for Disabled Persons and Oral Health-Related Indicators: A Population-Level Approach in Brazil's Public Healthcare System from 2014 to 2023.

This study evaluated territorial disparities in dental care for disabled persons in Brazil's public healthcare system from 2014 to 2023. The person-year incidence of outpatient dental procedures carried out by special care dentistry specialists and hospitalizations for dental procedures for disabled persons were compared across different regions and against the national estimate. In addition, productivity was correlated with oral health-related indicators. The significance level was set at 5%. The northern region exhibited the highest outpatient productivity, while the southern region showed lower productivity compared to the national estimate (both p-value < 0.05). This pattern was reversed in inpatient productivity (both p-value < 0.05), with the northeastern and central-western regions also below average (both p-value < 0.05). There were no significant correlations between the indicators and inpatient productivity, but outpatient productivity was positively correlated with the proportions of inhabitants who self-rated their general and oral health as "poor" or "very poor", who have never visited a dentist, and who visited a dentist for tooth extraction (all p-values < 0.05). Territorial disparities in dental care for disabled persons were observed within Brazil's public healthcare system, and they were correlated with unfavorable oral health-related indicators at the population level.

Analysis of hospital dental care for patients with special needs in Brazil.

This analytical cross-sectional study aimed to analyze the access of patients with special needs (PSN) in Brazilian municipalities to hospital dental care of the Unified Health System (Sistema Único de Saúde - SUS), based on data from the Hospital Information System of the Unified Health System (Sistema de Informações Hospitalares do SUS- SIH/SUS - SIH), from 2010 to 2018. The Kolmogorov-Smirnov normality test was performed; the Poisson regression was used to verify factors associated with the variable total number of hospitalization authorizations with the main procedure of dental treatment for PSN ("Total de Autorizações de Internação Hospitalar" - AIH), the Spearman correlation test with a significance level of 5% was used to characterize the relationships between the Municipal Human Development Index per municipality - (Índice de Desenvolvimento Humano Municipal - HDI) and the Oral Health Coverage in the Family Health Strategy by municipality (Cobertura de saúde bucal na estratégia saúde da família por município - SBSF Coverage), and the relationship of the AIH with SBSF Coverage. A total of 127,691 procedures were performed, of which 71,517 (56%) were clinical procedures, such as restorations, endodontic treatments, supra and subgingival scaling, among others. Municipalities in the Midwest (PR=5.117) and Southeast (RP = 4.443) regions had more precedures than the others. A weak correlation was found between AIH and SBSF Coverage (r = -0.2, p < 0.001) and HDI and SBSF Coverage (r = -0.074, p < 0.001). Population size, region, health coverage, oral hygiene, and number of dentists in hospitals affected the availability of dental procedures in PSN.

Dental core training in community dental services.

Community dental services (CDS) provide dental treatment for patients who cannot gain access or have treatment with their general dental practitioner. This includes groups of patients who are dentally phobic, medically compromised, or with physical or learning disabilities.This paper provides insight into the experience and the challenges of working in CDS as a dental core trainee (DCT). The post involves an equal split in the management of paediatric and special care dental patients.Patients seen in CDS can be split into cohorts such as paediatric, special care adults, dental anxious and others. Case discussions throughout the paper will illustrate commonly seen scenarios and exemplify patient management pathways though the service.NHS England Education provide training for DCTs through study days which focus on dental disciplines specific to their post.

Impact of income and financial subsidies on oral health care utilization among persons with disabilities in Singapore.

BACKGROUND/AIM(S): Globally, studies have shown that the dental disease burden among persons with intellectual and/or developmental disabilities (IDD) is high and can be attributed to lower utilization levels of dental services. The aim of the study was to assess the influence of income and financial subsidies on the utilization of dental care services among persons with IDD in Singapore. METHODS: Between August 2020 and August 2021, a cross-sectional study was conducted via centres offering Early Intervention Programme for Infants and Children, special education schools and adult associations in Singapore serving persons with IDD. A sample of 591 caregivers of children and adults with IDD completed the survey. Data on sociodemographic information, oral health behaviours and dental utilization were collected. Financial subsidy status was assessed by the uptake of a government-funded, opt-in Community Health Assist Scheme (CHAS) for low-income families that provided a fixed subsidy amount for dental services in the primary care setting. Statistical analysis was carried out using univariable, multiple logistic regression and modified Poisson regression. Propensity score matching was carried out in R version 4.0.2 to assess the impact of financial subsidies on oral health care utilization among persons with IDD. RESULTS: Compared to those with lower gross monthly household incomes, the adjusted prevalence ratios of having at least one dental visit in the past year, having at least one preventive dental visit in the past year, and visiting the dentist at least once a year for persons with IDD with gross monthly household incomes of above SGD$4000 were 1.28 (95% CI 1.08-1.52), 1.48 (95% CI 1.14-1.92) and 1.36 (95% CI 1.09-1.70), respectively. Among those who were eligible for CHAS Blue subsidies (247 participants), 160 (62.0%) took up the CHAS Blue scheme and 96 (35.4%) visited the dentist at least yearly. There was no statistically significant difference in the utilization of dental services among individuals enrolled in the CHAS Blue subsidy scheme among those eligible for CHAS Blue subsidies. CONCLUSION: Higher household income was associated with a higher prevalence of dental visits in the past year, preventive dental visits in the past year, and at least yearly dental visits. CHAS Blue subsidies alone had limited impact on dental utilization among persons with IDD who were eligible for subsidies.

Identifying people requiring special care dentistry: A scoping review.

AIMS: This scoping review aimed to document tools designed to identify persons requiring special care dentistry (SCD) and to provide a better understanding of the factors that justify adaptation in the provision of care. METHODS: A scoping review methodology was applied. An electronic search was performed in April 2021 using Pubmed and Embase. Additional tools were sought using hand searches and informal professional networking. RESULTS: Ten tools were identified that either predict the complexity of dental management or that retrospectively judge the complexity of care, of which two are as yet unpublished. Some had been developed for a specific population (e.g., patients with Alzheimer's disease, with learning disability, elderly persons) whilst others were applicable for any population (case mix tools). Factors considered included the patient's medical history, ability to cooperate, physical and cognitive autonomy, communication skills, anxiety, need for sedation, oral risk factors, ability to consent and the administrative burden for the dentist. CONCLUSION: Identifying persons requiring SCD is possible by looking at various factors that influence the provision of dental care. There may be need for adaptation of tools to local circumstances and to the intended usage of the tool at a health services, systems or policy level.

Dental care of disabled people: Descriptive cross-sectional study of social and medico-social establishments / Suivi bucco-dentaire des personnes handicapées : étude transversale descriptive en établissements sociaux et médico-sociaux

The first objective of this study, concerning the intervention of a dentist in social and medico-social establishments (SMSE), was to diagnose the oral care needs of disabled people (DP). The second objective was to raise awareness of a prevention and follow-up protocol among caregiving staff. We carried out this descriptive cross-sectional study from October 2016 to October 2018, in twenty SMSEs in Essonne. It involved a cohort of 663 volunteer DP, i.e., over 81 percent of the DP accommodated in these establishments. We analyzed DP's oral hygiene and health indicators, as well as changes in professional practices following simulation workshops, using Pearson's Chi-square test and Cramer's test to assess the existence of relationships between variables and their intensity, respectively. Of the 96 percent of DP who accepted a full screening, three-quarters had dental plaque and two-thirds had gingival inflammation, these pathologies being more frequent in the over-20s (p< 0.001 | Cramer's V=0.26). Only 14 percent had good oral health. Six months later, seventeen SMSEs had recorded dental check-ups in their medical records, and eight SMSEs had introduced brushing after dinner and breakfast, compared with ten and seven respectively before the intervention. This study confirmed the need for SMSEs to carry out dental screening. The involvement of establishments in monitoring the oral hygiene of DP must be strengthened.

Cette étude, menée dans le cadre de l'intervention d'un chirurgien-dentiste en établissements sociaux et médico-sociaux (ESMS), a eu comme premier objectif de poser un diagnostic sur les besoins en soins bucco-dentaires des personnes handicapées (PH). Le second objectif a été de parvenir à sensibiliser le personnel soignant à un protocole de prévention et de suivi. Cette étude transversale descriptive a été menée d'octobre 2016 à octobre 2018, auprès de 20 ESMS de l'Essonne et a concerné une cohorte de 663 PH volontaires, soit plus de 81 % des PH accueillies dans ces structures. Les indicateurs en hygiène et santé bucco-dentaire des PH, ainsi que l'évolution des pratiques professionnelles suite aux ateliers de mise en situation ont été analysés, via le test du Khi-deux de Pearson et celui de Cramer évaluant respectivement l'existence de relations entre variables et leur intensité. Parmi les 96 % des PH ayant accepté un dépistage complet, 3/4 présentaient de la plaque dentaire, 2/3 une inflammation gingivale, ces pathologies étant plus fréquentes chez les plus de 20 ans (p< 0.001 | V de Cramer= 0.26). Seuls 14 % avaient un bon état bucco-dentaire. Six mois après, 17 ESMS ont enregistré les suivis bucco-dentaires dans les dossiers médicaux et 8 ESMS instauré un brossage après le dîner et le petit déjeuner contre respectivement 10 et 7 avant l'intervention. Cette étude a conforté la nécessité de mener en ESMS des dépistages dentaires. L'implication des ESMS dans la surveillance de l'hygiène bucco-dentaire des PH reste à renforcer.

Special care in dentistry in France: Issues, current situation, outlook / Les soins spécifiques en odontologie en France : enjeux, état des lieux, perspectives

The question of oral health care and access to it for persons with disabilities is a key public health issue. This contribution describes the general landscape of access to oral health care for persons with disabilities since Law no.2005-102 of February 11, 2005, taking a broad approach that spans initial training and continuing education in the sector, the Romain Jacob charter, and the implementation of several networks. It also provides an analysis of the use of financial measures to incentivize the recognition of overtime spent providing care for persons with disabilities. The results of this study show that: considerable progress has been made in training; the missions of disability specialists must be redefined at the departmental level to enable these professionals to play their role; the enhanced financial recompense offered for this care is a step in the right direction but is insufficient to improve access to care for persons with disabilities; and, although care networks have proliferated, their future is uncertain given the precariousness of their funding. They remain, however, a system for providing care operating in parallel to mainstream care. While definite progress has been made over the past ten years, the Handifaction barometer shows that there is still much room for improvement as regards persons with disabilities' satisfaction with access to oral health care in France.

La question des soins buccodentaires et d'accès aux soins des personnes en situation de handicap est une question de santé publique primordiale. L'objectif est de décrire le paysage général de l'accès aux soins oraux des Personnes en situation de handicap depuis la loi du 11 février 2005. Un descriptif allant de la formation initiale à la formation continue en passant par l'engagement à appliquer la charte Romain Jacob et à la mise en place d'un certain nombre de réseaux est rapporté. Une analyse de l'utilisation des mesures pécuniaires incitatives à la prise en compte du temps supplémentaire de prise en soin des personnes handicapés est réalisé. Les résultats de ce descriptif montrent : Que de grands progrès ont été réalisés en matière de formation. Qu'une redéfinition des missions des référents handicap au niveau des ordres départementaux est nécessaire pour qu'ils puissent jouer leur rôle. Que la valorisation financière avec le supplément appliqué à la prise en charge est une avancée mais reste insuffisante pour améliorer l'accès aux soins des personnes en situation de handicap.Que les réseaux de soins se sont multipliés mais ont un avenir incertain compte tenu de la précarité de leur financement. Ils restent, cependant, un système de prise en charge parallèle à l'accès aux soins de droit commun. Si des progrès certains ont été constatés ces dix dernières années, le baromètre d'Handifaction reste très perfectible quant à la satisfaction des personnes en situation de handicap de l'accès aux soins buccodentaire sur le territoire.

An educational model for special patient care in dentistry.

Dental school graduates often have a basic knowledge in the management of patients with specialized healthcare needs. As of August 2019, CODA amended their accreditation standard 2-25: dental school graduates must be competent in the assessment and management of treatment of patients with specialized healthcare needs and disabilities. While the majority of these patients require modified dental care, many dental schools lack the facilities to provide both the proper care and education. This paper identifies improvements to dental education brought on by the innovations at Penn Dental Medicines' Personalized Care Suite for Persons with Disabilities (PCARE). Patient centered care is the emphasis of the PCARE curriculum. Although the clinic has special rooms and equipment to assist in accommodating the special needs of the patients, the program focuses on teaching dental students how to provide comfortable, safe, and effective care in a typical office setting. Detailed patient assessment, non-pharmacological management techniques, and treatment plans designed to meet the needs and abilities of the patients and caregivers are taught through lecture and direct patient care. Teaching assessment and management of this population is of great importance. Including treatment in Standard 2-25 creates another challenge to dental education. Penn Dental's facility allows multidisciplinary care in a cohesive and timely manner. The experience in PCARE offers unique opportunities to educate dental professionals in developing a patient centered approach in the treatment and maintenance of oral health in those patients who require accommodation.

Access to dental care for children with special health care needs: a cross-sectional community survey within Jeddah, Saudi Arabia.

The aim of this study was to investigate the level of dental care access among children with special health care needs (CSHCN) in Jeddah, Saudi Arabia and the barriers hindering this access. Data of this cross-sectional study were obtained from self-administered surveys distributed through seven CSHCN centers. Children with autistic spectrum disorder (ASD), Down syndrome, cerebral palsy, and developmental delay were included. Univariate and bivariate analyses were conducted to describe the data. A total of 602 study participants were included in the analyses. Only 24.9% of the participated caregivers routinely visited the dentist for their CSHCN. Half of CSHCN caregivers found difficulties obtaining dental treatment. This trend was significantly greater in 12-18 years old children (p = 0.013) and in families commuting for more than one hour to dental clinics (p = 0.045). The most common reported barrier was fear of the dentist (61.6%) followed by child uncooperativeness (37.8%) and treatment costs (27.8%). CSHCN lack sufficient dental care for a variety of reasons, primarily fear of dentists, child uncooperativeness, and treatment costs. Dentists require more training and education to facilitate better access to dental care for CSHCN.

OPERATIONALIZING ORAL HEALTH OUTCOME MEASURES TO IMPROVE THE ORAL HEALTH OF PERSONS WITH INTELLECTUAL DISABILITIES.

Individuals with intellectual disability (ID) face significant challenges in preventing oral diseases. They also lack access to high-quality oral health care in professional settings. To understand the effects of oral conditions on their lives and health, it is necessary to assess their oral health outcome measures. For those with mild ID, who possess adequate linguistic and cognitive abilities, accessibility features should be incorporated in the dental patient reported outcome (dPRO) measures. But many other individuals often lack the linguistic and cognitive ability to self-report through dPRO measures. While self-reported measures are preferable, requiring dPROs in this population would result in a high amount of missing data and the inability to assess interventions for improving their dental health. Thus, there is a need to use proxy-reported outcome (ProxRO) measures, observer reported outcome (ObsRO) measures, and clinician reported outcome (ClinRO) measures among those with ID. This is also a common approach taken by other specialties that work closely with those with ID, where the measures for activities of daily living and adaptive behavior measures use reporting by caregivers. ProxRO measures in dentistry that were created for infants and young children provide a structure for appropriate adaptations and the creation of relevant outcome measures. Including input from the intensely multidisciplinary teams that provide supports for those with ID is key to creating high-quality measures and oral health interventions for those with ID.

Dental treatment under general anesthesia in patients with severe intellectual disability at the Gregorio Marañón General University Hospital: a 10-year retrospective study.

OBJECTIVES: There is a high demand for dental treatment in a hospital setting for patients with severe intellectual disability (ID), due to their inability to cooperate. The objective was to determine the types of dental treatment carried out on patients with severe ID, as well as the possibility of performing clinical and radiographic examinations prior to treatment and to identify their characteristics. METHOD AND MATERIALS: A retrospective observational study was performed, based on the medical histories of patients with severe ID or a disability included in the portfolio of dental services of Community of Madrid, who underwent dental treatment at the Stomatology Service of the Gregorio Marañón General University Hospital from the year 2009 to 2019. Data on age, sex, etiology of disability, and dental treatment were obtained. RESULTS: A total of 1,845 patients were included. The type of disability in the majority of cases was unknown, followed by encephalopathy, cerebral paralysis, and Down syndrome. In total, 8,439 dental extractions were performed on 1,548 patients (83.9%). Clinical and radiographic exploration were carried out on 874 patients (47.4%). CONCLUSIONS: Ultrasonic scaling was the most frequently performed treatment in patients. Dental extractions were the next most common treatment. An increase in age showed a higher demand for surgical procedures and extractions. Over half of the patients (52.6%) did not tolerate clinical or radiographic examinations.

Are adults with autism receiving regular preventive dental services?

PURPOSE/AIM: To investigate the frequency of preventive dental care among adults with autism and explore factors associated with receiving regular preventive care. MATERIALS AND METHODS: De-identified data was collected from electronic health records of 18-year-old or older patients with autism that had at least one preventive dental procedure recorded. The data was then analyzed to describe the frequency of preventive dental procedures provided for this population and investigate what variables are associated with regular care. RESULTS: Sample size was 119, 67% were males, average age was 30.8 years, and 58% had Medicaid. Average BMI was 42.8, the prevalence of diabetes and heart disease were 16% and 34%, respectively, and 86% reported mental health problems. Recreational drug use was 6.8%, alcohol use was 19%, and tobacco use 16%. Xerostomia was reported by 32%, and the average number of medications was 7.2 ± 5.5. The average number of preventive dental visits was 7.9 ± 10.6, and 35% of the patients had at least one preventive dental visit per year. Only number of medications had a statistically significant association with number of preventive dental visits. CONCLUSIONS: Only one in every three adults with autism had at least one preventive dental visit per year.

Perfil epidemiológico dos pacientes com necessidades especiais em Sergipe / Epidemiological profile of patients with special needs in Sergipe

Introdução:No Brasil, em 2010, aproximadamente 24% da população apresentava algum tipo de deficiência e 25% da população no estado de Sergipe. Devido a tal demanda, em 2004, foi criada a Política Nacional de Saúde Bucal que, entre outras, foi instituída o atendimento em nível secundário em saúde para as Pessoas com Deficiência (PD). Objetivo:Verificar o perfil das PD atendidas no Centro de Especialidades Odontológicos (CEO) de São Cristóvão/SE e os procedimentos odontológicos mais realizados. Materiais e métodos:Para tal, foram analisados os prontuários dos PD atendidos no período de janeiro de 2019 até setembro de 2022. Resultados:Foi verificado que houve atendimento em 2019 de 101 pacientes, 2020 de 71 pacientes, 2021 em 33 pacientes e, em 2022, 87 pacientes. Acidade de origem dos PD é em 68,7 % do município sede do CEO (São Cristóvão). Sobre o diagnóstico dos pacientes, os mais prevalecentes foram autismo (10%), seguido de síndrome de Down (4%) e paralisia cerebral (4%). Do total de procedimentos realizados, 160 ATF (Aplicação Tópica de Flúor), seguido por 148 profilaxias, 116 adequações do meio bucal, 138 exodontias, 98 restaurações com resina, 58 restaurações com amálgama, 111 atendimentos de periodontia (raspagem e alisamento radicular) e 45 orientações de higiene oral. Conclusões: Diante dos dados, observou-se que o CEO de São Cristóvão se comporta com predomínio de atendimentos de seus munícipes e ainda há alta prevalência de atendimento de exodontias.

Rede de cuidados à pessoa com deficiência: o direito à saúde bucal e a implementação da assistência odontológica especializada / Care network for persons with disabilities: the right to oral health and the implementation of specialized dental care

A implementação de políticas públicas depende das interrelações entre Estado, sociedade, política e economia, as quais produzem efeitos que irão repercutir na vida das pessoas. Na literatura, diferentes modelos teóricos estão disponíveis para estudo da implementação de políticas públicas. A relevância das necessidades de saúde da pessoa com deficiência cresceu, após a aprovação da Declaração dos Direitos das Pessoas com Deficiência (PcD), elevando a consciência sobre a necessidade da implementação de políticas públicas efetivas e duradouras de inclusão das PcD. Esta tese objetivou estudar o processo de implementação da Rede de Cuidados à Pessoa com Deficiência (RCPD) a partir do Modelo de Coalização de Defesa e da teoria da Burocracia do Nível de Rua; e descrever a extensão da integração sistêmica que orienta a conformação do cuidado da RCPD, no âmbito da saúde bucal, em seis regiões de saúde brasileiras, bem como produzir uma síntese de recomendações/expectativas sobre a assistência odontológica às PcD, adicionalmente. Para a viabilização dos resultados, foram utilizados dois métodos de pesquisa: o estudo de caso (único e múltiplo) e a revisão integrativa. Os resultados foram a elaboração de quatro artigos que tratam sobre: a descrição, sob o Modelo de Coalizão de Defesa, das condições que favoreceram a conformação do subsistema da política pública e o processo de implementação da RCPD em duas regiões de saúde brasileiras semelhantes (Artigo 1); a descrição da influência da discricionariedade dos profissionais e organizações da linha de frente na implementação de diferentes formas de acesso à assistência odontológica especializada na RCPD (Artigo 2); a produção de uma síntese da literatura científica sobre as expectativas/recomendações a respeito da assistência odontológica como direito à saúde bucal para pessoas com deficiência no âmbito internacional (Artigo 3); e a descrição da extensão da integração sistêmica da assistência odontológica na RCPD, em seis regiões de saúde brasileiras (Artigo 4). No contexto internacional, o direito à saúde bucal para PcD atravessa um cenário complexo e por vezes contraditório, afetado pelo modelo de proteção social dos países abordados pelos pesquisadores. No Brasil, os estudos de caso mostraram que a implementação da RCPD sofreu influência das crenças/convicções dos seus implementadores, bem como do poder discricionário deles. Além disso; a extensão da integração sistêmica foi influenciada pela indução federal, e pelas características do contexto loco-regional no processo de implementação da RCPD no âmbito da saúde bucal.

The implementation of public policies depends on the interrelationships between the State, society, policy and economy, which produce effects that will have repercussions on people's lives. In the literature, different theoretical models are available to study the implementation of public policies. The relevance of the health needs of people with disabilities grew after the approval of the Declaration of the Rights of People with Disabilities (PwD), raising awareness of the need to implement effective and lasting public policies for the inclusion of PwD. This thesis aimed to study the implementation process o f the Care Network for People with Disabilities (CNPD) based on the Defense Coalition Model and the Street Levei Bureaucracy theory; and describe the extent of systemic integration that guides the shaping of CNPD care, within the scope of oral health, in six brazilian health regions, as well as producing a synthesis of recommendations/expectations regarding dental care for PwD, in addition. To make the results viable, two research methods were used: the case study (single and multiple) and the integrative review. The results were the elaboration o f four articles that deal with: the description, under the Advocay Coalition Framework, o f the conditions that favored the conforrnation ofthe public policy subsystem and the process of implementing the CNPD in two similar Brazilian health regions (Article 1); the description ofthe influence ofthe discretion offrontline professionals and organizations in the implementation of different forms of access to specialized dental care in the CNPD (Article 2); the production of a synthesis of the scientific literature of expectations/recommendations regarding dental care as a right to oral health for people with disabilities at the international levei (Article 3); and the description of the extent of the systemic integration of dental care in the CNPD, in six Brazilian health regions (Article 4). At international context, the right to oral health for PwD has been crossed by a complex and sometimes contradictory scenario, affected by the social protection model o f the countries addressed by the researchers. In Brazil, the case studies showed that the implementation o f the CNPD was influenced by the beliefs/convictions of its implementers, as well as their discretion. Moreover, the extent of systemic integration was influenced by federal induction, in addition to characteristics o f the loco-regional context in the process of implementing the CNPD in the field of oral health.

Publication Trends Studies Involving Disabled Persons with Dental Care Needs: A 20-Year Bibliometric Analysis

ABSTRACT Objective: To evaluate scientific production on disabled persons with dental care needs over a 20-year period. Material and Methods: The search was conducted in the PubMed database using the MeSH terms "Disabled Persons" AND "Dentistry". Three researchers selected articles based on readings of the title, abstract and full text. The articles were categorized according to periodical, country, study design, subject and classification of comorbidities and associated disorders. Three hundred ninety-seven articles published in 140 periodicals were included. Results: The periodicals Special Care in Dentistry (54), Dental Clinics of North America (14) and British Dental Journal (14) accounted for 21% of the publications. The studies were conducted in 50 countries, with the United States accounting for 33%. More than half (52%) of the studies had a cross-sectional design. The main subject addressed was oral diagnosis and most of the comorbidities were generalized disabilities. Conclusion: Although a large number of the periodicals have contributed to knowledge building on disabled persons with dental care needs, the number of articles is small compared to other fields of dentistry. Moreover, important gaps in knowledge persist and projects with better methodological designs are needed to offer a more substantial contribution to clinical practice.

Dental care for patients with special needs at a private higher education institute / Atendimento odontológico a pacientes com necessidades especiais em uma instituição privada de ensino superior

Objetivo: Pacientes com necessidades especiais são aqueles indivíduos que necessitam de cuidados especiais por tempo indeterminado ou por toda a vida. O presente estudo tem como objetivo abordar o atendimento odontológico de pacientes com necessidades especiais em uma instituição privada de ensino superior da cidade de São Paulo. Material e Métodos: Foi realizado um estudo descritivo, retrospectivo, para análise de 210 prontuários odontológicos de pacientes com necessidades especiais atendidos no Departamento de Odontologia para Pacientes Especiais da Universidade Cruzeiro do Sul entre 2012 e 2018. Dados sobre sexo, idade, diagnóstico da condição debilitante, motivo da consulta, uso continuado de medicamentos, imagens radiográficas e tratamentos odontológicos prestados foram todos coletados e posteriormente submetidos à análise estatística descritiva e inferencial (teste do qui-quadrado) ao nível de significância de 5%. Resultados: Quanto aos tipos de procedimentos odontológicos avaliados no presente estudo, dos 210 pacientes, 24% necessitaram de tratamentos curativos dentários em que a terapia periodontal foi o tipo mais prevalente, enquanto os tratamentos endodônticos tiveram a menor prevalência, representando apenas 4%. Houve alta prevalência de doenças crônicas sistêmicas, acometendo 56% dos casos, cuja faixa etária era superior a 40 anos. Conclusão: Check-ups odontológicos regulares devem ser priorizados em pacientes com necessidades especiais para evitar intervenções mais invasivas como em nosso grupo (AU)

Objective: Patients with special needs are those individuals who need special care for an undetermined period of time or for lifetime. The present study is aimed to address the dental care of special needs patients at a private higher education institute in the city of São Paulo. Material and Methods: A descriptive, retrospective study was performed for analysis of 210 dental records of special needs patients who were treated at the Dental Department for Special Patients of the Cruzeiro do Sul University between 2012 and 2018. Data on gender, age, diagnosis of the debilitating condition, reason of the consultation, continued use of medications, radiographic images and dental treatments provided were all collected before being submitted to descriptive and inferential statistical analysis (chi-square test) at a significance level of 5%. Results: As for the types of dental procedures assessed in the present study, of the 210 patients, 24% needed dental curative treatments in which periodontal therapy was the most prevalent type, whereas endodontic treatments had the lowest prevalence, representing 4% only. There was a high prevalence of chronic systemic diseases, affecting 56% of the dental records, whose age group was above 40 years old. Conclusion: Regular dental check-ups should be prioritized in patients with special needs to avoid more invasive interventions as found in our group (AU)